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Wang G, Chen X, Meng L, Liu Y, Dai Y, Wang W. The Application Effect of Craniotomy through Transsylvian Rolandic Point-Insular Approach on Hypertensive Intracerebral Hemorrhage in Posterior Basal Ganglia. Behav Neurol 2023; 2023:2266691. [PMID: 38074419 PMCID: PMC10699897 DOI: 10.1155/2023/2266691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/18/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Objective To evaluate the hematoma clearance and safety of small bone window craniotomy through the lateral fissure Rolandic point-insular lobe approach for patients with hypertensive intracerebral hemorrhage (HICH) in posterior basal ganglia. Methods This retrospective study enrolled a total of 86 patients with HICH in the posterior basal ganglia region who underwent surgery between January 2020 and December 2021. These patients were divided into two groups: the conventional group and the study group. The intraoperative information, postoperative hematoma clearance rate, increasing rate of cerebral edema and rebleeding occurrence rate, postoperative complication rate, and prognoses were compared between the two groups. Additionally, we observed and compared the rate of postoperative cerebral hematoma increase, as well as the neurological function and activities of daily living (ADL) at admission, 3 months, and 6 months after surgery in both groups. Univariate and multivariate logistic regression analyses were performed to explore factors affecting the prognosis of patients with HICH in the posterior basal ganglia region after small bone window craniotomy through the lateral fissure Rolandic point-insular lobe approach. Results The study group exhibited significantly shorter automatic eye-opening times and hospital stays compared to the conventional group (P < 0.05). Furthermore, the study group demonstrated better hematoma clearance rates, lower rates of cerebral hematoma at postoperative 48 h and 72 h, and lower rates of rebleeding compared to the conventional group (P < 0.05). At 3 and 6 months postsurgery, the study group exhibited a significantly greater improvement in neurological function and ADL compared to the conventional group (P < 0.05). Additionally, the incidence of postoperative complications in the study group was lower than that in the conventional group (P < 0.05). Furthermore, the prognosis of the study group was significantly better than that of the conventional group at the 6-month follow-up (P < 0.05). Conclusion A small bone window craniotomy via transsylvian Rolandic point-insular approach has been shown to improve the hematoma clearance rate in patients with HICH in the posterior basal ganglia region while also reducing the incidence of complications. This approach is highly safe and feasible for implementation in clinical practice.
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Affiliation(s)
- Guobing Wang
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Xin Chen
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Linghu Meng
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Ying Liu
- Department of Gynecology and Obstetrics, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Yongjian Dai
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Wenxin Wang
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
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Liu Q, Tang Y, Tao W, Tang Z, Wang H, Nie S, Wang N. Early transthoracic echocardiography and long-term mortality in moderate- to-severe acute respiratory distress syndrome: An analysis of the Medical Information Mart for Intensive Care database. Sci Prog 2023; 106:368504231201229. [PMID: 37801611 PMCID: PMC10560446 DOI: 10.1177/00368504231201229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
BACKGROUND The clinical use of transthoracic echocardiography (TTE) in patients with acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) has dramatically increased, its impact on long-term prognosis in these patients has not been studied. This study aimed to explore the effect of early-TTE on long-term mortality in patients with moderate-to-severe ARDS in ICU. METHODS A total of 2833 patients with moderate-to-severe ARDS who had or had not received early-TTE were obtained from the Medical Information Mart for Intensive Care (MIMIC-III) database after imputing missing values by a random forest model, patients were divided into early-TTE group and non-early-TTE group according to whether they received TTE examination in ICU. A variety of statistical methods were used to balance 41 covariates and increase the reliability of this study, including propensity score matching, inverse probability of treatment weight, covariate balancing propensity score, multivariable regression, and doubly robust estimation. Chi-Square test and t-tests were used to examine the differences between groups for categorical and continuous data, respectively. RESULTS There was a significant improvement in 90-day mortality in the early-TTE group compared to non-early-TTE group (odds ratio = 0.79, 95% CI: 0.64-0.98, p-value = 0.036), revealing a beneficial effect of early-TTE. Net-input was significantly decreased in the early-TTE group on the third day of ICU admission and throughout the ICU stay, compared with non-early-TTE group (838.57 vs. 1181.89 mL, p-value = 0.014; 4542.54 vs. 8025.25 mL, p-value = 0.05). There was a significant difference in the reduction of serum lactate between the two groups, revealing the beneficial effect of early-TTE (0.59 vs. 0.83, p-value = 0.009). Furthermore, the reduction in the proportion of acute kidney injury demonstrated a correlation between early-TTE and kidney protection (33% vs. 40%, p-value < 0.001). CONCLUSIONS Early application of TTE is beneficial to improve the long-term mortality of patients with moderate-to-severe ARDS.
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Affiliation(s)
- Qiuyu Liu
- Department of Critical Care Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Yingkui Tang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wu Tao
- Department of Critical Care Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Ze Tang
- Department of Critical Care Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Hongjin Wang
- Department of Critical Care Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Shiyu Nie
- Department of Critical Care Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Nian Wang
- Department of Critical Care Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
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Das AS, Gokcal E, Biffi A, Regenhardt RW, Pasi M, Abramovitz Fouks A, Viswanathan A, Goldstein J, Schwamm LH, Rosand J, Greenberg SM, Gurol ME. Mechanistic Implications of Cortical Superficial Siderosis in Patients With Mixed Location Intracerebral Hemorrhage and Cerebral Microbleeds. Neurology 2023; 101:e636-e644. [PMID: 37290968 PMCID: PMC10424843 DOI: 10.1212/wnl.0000000000207476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hypertensive cerebral small vessel disease (HTN-cSVD) is the predominant microangiopathy in patients with a combination of lobar and deep cerebral microbleeds (CMBs) and intracerebral hemorrhage (mixed ICH). We tested the hypothesis that cerebral amyloid angiopathy (CAA) is also a contributing microangiopathy in patients with mixed ICH with cortical superficial siderosis (cSS), a marker strongly associated with CAA. METHODS Brain MRIs from a prospective database of consecutive patients with nontraumatic ICH admitted to a referral center were reviewed for the presence of CMBs, cSS, and nonhemorrhagic CAA markers (lobar lacunes, centrum semiovale enlarged perivascular spaces [CSO-EPVS], and multispot white matter hyperintensity [WMH] pattern). The frequencies of CAA markers and left ventricular hypertrophy (LVH), a marker for hypertensive end-organ damage, were compared between patients with mixed ICH with cSS (mixed ICH/cSS[+]) and without cSS (mixed ICH/cSS[-]) in univariate and multivariable models. RESULTS Of 1,791 patients with ICH, 40 had mixed ICH/cSS(+) and 256 had mixed ICH/cSS(-). LVH was less common in patients with mixed ICH/cSS(+) compared with those with mixed ICH/cSS(-) (34% vs 59%, p = 0.01). The frequencies of CAA imaging markers, namely multispot pattern (18% vs 4%, p < 0.01) and severe CSO-EPVS (33% vs 11%, p < 0.01), were higher in patients with mixed ICH/cSS(+) compared with those with mixed ICH/cSS(-). In a logistic regression model, older age (adjusted odds ratio [aOR] 1.04 per year, 95% CI 1.00-1.07, p = 0.04), lack of LVH (aOR 0.41, 95% CI 0.19-0.89, p = 0.02), multispot WMH pattern (aOR 5.25, 95% CI 1.63-16.94, p = 0.01), and severe CSO-EPVS (aOR 4.24, 95% CI 1.78-10.13, p < 0.01) were independently associated with mixed ICH/cSS(+) after further adjustment for hypertension and coronary artery disease. Among ICH survivors, the adjusted hazard ratio of ICH recurrence in patients with mixed ICH/cSS(+) was 4.65 (95% CI 1.38-11.38, p < 0.01) compared with that in patients with mixed ICH/cSS(-). DISCUSSION The underlying microangiopathy of mixed ICH/cSS(+) likely includes both HTN-cSVD and CAA, whereas mixed ICH/cSS(-) is likely driven by HTN-cSVD. These imaging-based classifications can be important to stratify ICH risk but warrant confirmation in studies incorporating advanced imaging/pathology.
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Affiliation(s)
- Alvin S Das
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston.
| | - Elif Gokcal
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Alessandro Biffi
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Robert W Regenhardt
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Marco Pasi
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Avia Abramovitz Fouks
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anand Viswanathan
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Joshua Goldstein
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Lee H Schwamm
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Rosand
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Steven M Greenberg
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - M Edip Gurol
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
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Das AS, Gokcal E, Regenhardt RW, Horn MJ, Schwab K, Daoud N, Viswanathan A, Kimberly WT, Goldstein JN, Biffi A, Rost N, Rosand J, Schwamm LH, Greenberg SM, Gurol ME. Improving detection of cerebral small vessel disease aetiology in patients with isolated lobar intracerebral haemorrhage. Stroke Vasc Neurol 2023; 8:26-33. [PMID: 35981809 PMCID: PMC9985798 DOI: 10.1136/svn-2022-001653] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE We evaluate whether non-haemorrhagic imaging markers (NHIM) (white matter hyperintensity patterns, lacunes and enlarged perivascular spaces (EPVS)) can discriminate cerebral amyloid angiopathy (CAA) from hypertensive cerebral small vessel disease (HTN-cSVD) among patients with isolated lobar intracerebral haemorrhage (isolated-LICH). METHODS In patients with isolated-LICH, four cSVD aetiologic groups were created by incorporating the presence/distribution of NHIM: HTN-cSVD pattern, CAA pattern, mixed NHIM and no NHIM. CAA pattern consisted of patients with any combination of severe centrum semiovale EPVS, lobar lacunes or multiple subcortical spots pattern. HTN-cSVD pattern consisted of any HTN-cSVD markers: severe basal ganglia PVS, deep lacunes or peribasal ganglia white matter hyperintensity pattern. Mixed NHIM consisted of at least one imaging marker from either pattern. Our hypothesis was that patients with HTN-cSVD pattern/mixed NHIM would have a higher frequency of left ventricular hypertrophy (LVH), which is associated with HTN-cSVD. RESULTS In 261 patients with isolated-LICH, CAA pattern was diagnosed in 93 patients, HTN-cSVD pattern in 53 patients, mixed NHIM in 19 patients and no NHIM in 96 patients. The frequency of LVH was similar among those with HTN-cSVD pattern and mixed NHIM (50% vs 39%, p=0.418) but was more frequent in HTN-cSVD pattern compared with CAA pattern (50% vs 20%, p<0.001). In a regression model, HTN-cSVD pattern (OR: 7.38; 95% CI 2.84 to 19.20) and mixed NHIM (OR: 4.45; 95% CI 1.25 to 15.90) were found to be independently associated with LVH. CONCLUSION Among patients with isolated-LICH, NHIM may help differentiate HTN-cSVD from CAA, using LVH as a marker for HTN-cSVD.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Elif Gokcal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell J Horn
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nader Daoud
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - W Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Das AS, Regenhardt RW, Gokcal E, Horn MJ, Daoud N, Schwab KM, Rost NS, Viswanathan A, Kimberly WT, Goldstein JN, Biffi A, Schwamm LH, Rosand J, Greenberg SM, Gurol ME. Idiopathic primary intraventricular hemorrhage and cerebral small vessel disease. Int J Stroke 2022; 17:645-653. [PMID: 34427471 PMCID: PMC10947797 DOI: 10.1177/17474930211043957] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although primary intraventricular hemorrhage is frequently due to trauma or vascular lesions, the etiology of idiopathic primary intraventricular hemorrhage (IP-IVH) is not defined. AIMS Herein, we test the hypothesis that cerebral small vessel diseases (cSVD) including hypertensive cSVD (HTN-cSVD) and cerebral amyloid angiopathy are associated with IP-IVH. METHODS Brain magnetic resonance imaging from consecutive patients (January 2011 to September 2019) with non-traumatic intracerebral hemorrhage from a single referral center were reviewed for the presence of HTN-cSVD (defined by strictly deep or mixed-location intracerebral hemorrhage/cerebral microbleeds) and cerebral amyloid angiopathy (applying modified Boston criteria). RESULTS Forty-six (4%) out of 1276 patients were identified as having IP-IVH. Among these, the mean age was 74.4 ± 12.2 years and 18 (39%) were females. Forty (87%) had hypertension, and the mean initial blood pressure was 169.2 ± 40.4/88.8 ± 22.2 mmHg. Of the 35 (76%) patients who received a brain magnetic resonance imaging, two (6%) fulfilled the modified Boston criteria for possible cerebral amyloid angiopathy and 10 (29%) for probable cerebral amyloid angiopathy. Probable cerebral amyloid angiopathy was found at a similar frequency when comparing IP-IVH patients to the remaining patients with primary intraparenchymal hemorrhage (P-IPH) (27%, p = 0.85). Furthermore, imaging evidence for HTN-cSVD was found in 8 (24%) patients with IP-IVH compared to 209 (28%, p = 0.52) patients with P-IPH. CONCLUSIONS Among IP-IVH patients, cerebral amyloid angiopathy was found in approximately one-third of patients, whereas HTN-cSVD was detected in 23%-both similar rates to P-IPH patients. Our results suggest that both cSVD subtypes may be associated with IP-IVH.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elif Gokcal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mitchell J Horn
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nader Daoud
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin M Schwab
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Natalia S Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - W Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Frequency, Predictors, Etiology, and Outcomes for Deep Intracerebral Hemorrhage without Hypertension. J Stroke Cerebrovasc Dis 2022; 31:106293. [PMID: 35016096 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Some patients with deep intracerebral hemorrhage (ICH) have a transient hypertensive response and they may be erroneously classified as secondary to hypertension. We investigated frequency, risk factors, and outcomes for patients with deep ICH without hypertension. MATERIALS AND METHODS We consecutively recruited patients with spontaneous ICH attending two Spanish stroke centers (January 2015-June 2019). Excluded were patients with lobar/infratentorial ICH and patients who died during hospitalization. We defined deep ICH without hypertension when the bleeding was in a deep structure, no requirement for antihypertensive agents during follow-up and no evident chronic hypertension markers evaluated by transthoracic echocardiography, 24 h ambulatory blood pressure monitoring and/or electrocardiography. We compared clinical, radiological, and 3-month functional outcome data for deep-ICH patients with hypertension versus those without hypertension. RESULTS Of 759 patients with ICH, 219 (mean age 69.6 ± 15.4 years, 54.8% men) met the inclusion criteria and 36 (16.4%) did not have hypertension. Of these 36 patients, 19 (52.7%) had a transient hypertensive response. Independent predictors of deep ICH without hypertension were age (adjusted OR:0.94;95%CI:0.91-0.96) and dyslipidemia (adjusted OR:0.27;95% CI:0.08-0.85). One third of deep ICH without hypertension were secondary to vascular malformations. Favorable outcomes (modified Rankin Scale 0-2) were more frequent in patients with deep ICH without hypertension compared to those with hypertension (70.9% vs 33.8%; p < 0.001). CONCLUSION Of patients with deep ICH, 16.4% were unrelated with hypertension, around half showed hypertensive response, and around a third had vascular malformations. We suggest studying hypertension markers and performing a follow-up brain MRI in those patients with deep ICH without prior hypertension.
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Wei JH, Tian YN, Zhang YZ, Wang XJ, Guo H, Mao JH. Short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive int racerebral hemorrhage. World J Clin Cases 2021; 9:8358-8365. [PMID: 34754845 PMCID: PMC8554417 DOI: 10.12998/wjcc.v9.i28.8358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/02/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypertensive intracerebral hemorrhage is a common critical disease of the nervous system, comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality rate. It severely affects the patients’ quality of life.
AIM To analyze the short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage.
METHODS From March 2018 to May 2020, 118 patients with hypertensive intracerebral hemorrhage were enrolled in our study and divided into a control group and observation group according to the surgical plan. The control group used a hard-channel minimally invasive puncture and drainage procedure. The observation group underwent minimally invasive neuroendoscopic surgery. The changes in the levels of serum P substances (SP), inflammatory factors [tumor necrosis factor-α, interleukin-6 (IL-6), IL-10], and the National Hospital Stroke Scale (NIHSS) and Barthel index scores were recorded. Surgery related indicators and prognosis were compared between the two groups.
RESULTS The operation time (105.26 ± 28.35) of the observation group was min longer than that of the control group, and the volume of intraoperative bleeding was 45.36 ± 10.17 mL more than that of the control group. The hematoma clearance rates were 88.58% ± 4.69% and 94.47% ± 4.02% higher than those of the control group at 48 h and 72 h, respectively. Good prognosis rate (86.44%) was higher in the observation group than in the control group, and complication rate (5.08%) was not significantly different from that of the control group (P > 0.05).The SP level and Barthel index score of the two groups increased (P < 0.05) and the inflammatory factors and NIHSS score decreased (P < 0.05). The cytokine levels, NIHSS score, and Barthel index score were better in the observation group than in the control group (P < 0.05).
CONCLUSION Neuroendoscopic minimally invasive surgery is more complicated than hard channel minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage; however, hematoma clearance is more thorough, and the short-term effect and long-term prognosis are better than hard channel minimally invasive puncture drainage.
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Affiliation(s)
- Jian-Hui Wei
- Department of Neurosurgery, Harrison International Peace Hospital, Hengshui 053000, Hebei Province, China
| | - Ya-Nan Tian
- Department of Neurology, Harrison International Peace Hospital, Hengshui 053000, Hebei Province, China
| | - Ya-Zhao Zhang
- Department of Neurology, Harrison International Peace Hospital, Hengshui 053000, Hebei Province, China
| | - Xue-Jing Wang
- Department of Neurology, Harrison International Peace Hospital, Hengshui 053000, Hebei Province, China
| | - Hong Guo
- Department of Neurology, Harrison International Peace Hospital, Hengshui 053000, Hebei Province, China
| | - Jian-Hui Mao
- Department of Neurology, Harrison International Peace Hospital, Hengshui 053000, Hebei Province, China
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Qian X, Lan S, Zhang X. Effects of mild hypothermia therapy combined with minimally invasive debridement in patients with hypertensive intracranial hemorrhage: a randomized controlled study. Am J Transl Res 2021; 13:7997-8003. [PMID: 34377281 PMCID: PMC8340259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the clinical effect of mild hypothermia therapy (MHT) combined with minimally invasive debridement (MID) in patients with severe hypertensive intracranial hemorrhage (HICH). METHODS A total of 120 patients with severe HICH who received clinical intervention in our hospital were enrolled as study subjects. In this randomized, controlled, double-blind trial, they were divided into a study group (SG, n=70) and a control group (CNG, n=50). The CNG was treated with MID, and the SG was treated with MID combined with MHT. The general surgical indices, short-term postoperative outcomes, postoperative neurological and recovery in activities of daily living, and complications were compared between the two groups. Patients' Glasgow prognosis (Glasgow Outcome Scale, GOS) scores at 1 year after surgery were analyzed. RESULTS The operative time, intraoperative blood loss and intensive care unit (ICU) admission were shorter/lower in the SG than in the CNG (P<0.05). The SG had higher hematoma clearance rate at 1 d and 3 d postoperatively, and lower residual hematoma volume at 3 d and 7 d postoperatively than the CNG (P<0.05). Patients in the SG had higher Barthel scores and lower National Institutes of Health Stroke Scale (NIHSS) scores than the CNG at 1-12 months after intervention (P<0.05). The incidence of complications in the SG was lower than that in the CNG (P<0.05). The percentage of GOS grade IV and V was significantly higher in the SG than in the CNG 1 year after surgery (P<0.05). CONCLUSION The combination of MID and MHT in patients with severe HICH has better clinical results in the short and long term, and improves the postoperative outcomes and quality of life. It can also reduce the incidence of perioperative complications.
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Affiliation(s)
- Xuping Qian
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Hospital of Huzhou Normal UniversityHuzhou 313000, Zhejiang Province, China
| | - Shali Lan
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Hospital of Huzhou Normal UniversityHuzhou 313000, Zhejiang Province, China
| | - Xiaohua Zhang
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Hospital of Huzhou Normal UniversityHuzhou 313000, Zhejiang Province, China
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